Presented By Ahmad Ramdhani Amir Mahafendy S. Tukan Nur Afeeza Emil Kardani Henry Liemer Wijaya Advisor Dr. Hendrian Chaniago Dr. Harianto Simbolon Dr. Luthfi Muammar SUpervisor
MEDICAL FACULTY OF HASANUDDIN UNIVERSITY MAKASSAR 2013
Introduction
Inflamation of the joint or fractured bone can
cause painful limb thus can result muscle spasm Purpose of traction is
To relive pain and allow the limb to be rested To immobilize a joint or part of the body
To prevent or reduce muscle spasm
Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
Skin Traction
Skeletal Traction
SKIN TRACTION
Skin Traction
The force is applied over the large area of skin
distal to the fracture site, otherwise the efficiency of the traction force is reduced
Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
Skin Traction
Adhesive
Strapping can only stretched transversely Limited force max.15 lb (6.7kg) Elastoplast Skin Traction Kit, Tractac, Seton Skin Traction Kit, Orthotrac, and Skin-Trac
Non adhesive
The grip is less secure Frequent reapplications may be necessary Limited force max.10 lb (4.5kg) Ventfoam Skin Traction Bandage, Specialist Foam Traction, and Notac Trantion
Skin Traction
Adhesive Non adhesive
Bucks Traction
Often used
preoperatively for femoral fractures Can use tape or premade boot No more than 10 lbs Not used to obtain or hold reduction
Brooker AF, Schmeisser G. Orthopaedic Traction Manual. 1980. London: Williams & Wilkins
Contraindications
Impairment of circulation
Dermatitis
Abrasions of the skin Laceration of the skin in the area to which the
traction to be applied
Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
Complications
Excoriating of the skin from slipping of the
adhesive strapping Common peroneal nerve palsy Pressure sores around the malleoli and over the tendocalcaneus Allergic reaction to adhesive
Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
SKELETAL TRACTION
Skeletal Traction
A metal pin or wire is driven through the bone in
Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
Denham pin
Kirschner wire
Denham pin
Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
of the Kirschner wire is s -1 inch (2,0 2,5cm) proximal to the distal end of the second metacarpal The wire traverses the second and the third metacarpal Position for K-wire in second and third metacarpal transversely to lie at right angles to the Brooker AF, Schmeisser G. Orthopaedic Traction Manual. 1980. London: Williams & Wilkins longitudinal axis of
the femur, 1 inch (2,5 cm) below the most prominent part of the greater trochanter, mid-way between the anterior and posterior surface of the femur.
Position for screw eye in upper end of femur for lateral femoral traction
Brooker AF, Schmeisser G. Orthopaedic Traction Manual. 1980. London: Williams & Wilkins
Position for Steinmann pin in lower end of femur and upper end of tibia
Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
CALCANEUS The point insertion is inch (2,0 cm) below and behind th lateral malleolus. (as the lateral malleolus lies inch more posterior and distal than the medial malleolus, the above point correspondens with that 1 inches below and behind the malleolus. Care must be taken to avoid entering the subtalar join Stewart, JDM. Hallet, JP. Traction and Orthopaedic
Appliances. 2nd ed. London : Churchill Livingstone
Position for Steinmann pin in lower end of tibia and calcaneus Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
The limb must be held in the same degree of lateral rotation as the normal limb; the Steinmann pin lies horizontally
The steinmann pin is inserted at right angles to the longitudinal axis of the limb
Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
Complications
Introduction of infection into bone 2. Incorrect placement of the pin or wire may - Allow the pin or wire to cut out of the bone causing pain and the failure of the traction system - Make control of rotation of the limb difficult - Make the application of splint difficult
1.
Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
Complications
Distraction at the fracture site as very large traction force can be applied through skeletal traction 4. Ligamentous damage if a large traction force is applied through a joint for a prolonged period of time 5. Damage to epiphyseal growth plate when use in children 6. Depressed scar
3.
Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
wrap Useful for elevation in any injury Can treat difficult clavicle fractures with excellent cosmetic result Risk is skin loss
Brooker AF, Schmeisser G. Orthopaedic Traction Manual. 1980. London: Williams & Wilkins
tuberosity or prox humeral shaft fx Arm abducted 30 degrees Elbow flexed 90 degrees 7-10 lbs on forearm 5-7 lbs on arm Risk of ischemia at Brooker AF, Schmeisser G. Orthopaedic Traction antecubital fossa
Manual. 1980. London: Williams & Wilkins
Dunlops Traction
Used for supracondylar
and transcondylar fractures in children Used when closed reduction difficult or traumatic Forearm skin traction with weight on upper arm Elbow flexed 45 degrees Brooker AF, Schmeisser G. Orthopaedic Traction
Manual. 1980. London: Williams & Wilkins
fractures of the long bones Requires bed rest Used when surgery can not be done for one reason or another Uses skin and skeletal traction
Stewart, JDM. Hallet, JP. Traction and Orthopaedic Appliances. 2nd ed. London : Churchill Livingstone
for acetabular fractures Lateral traction for fractures with medial or anterior force Stretched capsule and ligamentum may reduce acetabular fragments
Brooker AF, Schmeisser G. Orthopaedic Traction Manual. 1980. London: Williams & Wilkins
Brooker AF, Schmeisser G. Orthopaedic Traction Manual. 1980. London: Williams & Wilkins
Bryants Traction
Useful for treatment
femoral shaft fx in infant or small child Combines gallows traction and Bucks traction Raise mattress for countertraction Rarely, if ever used Brooker AF, Schmeisser G. Orthopaedic Traction currently
Manual. 1980. London: Williams & Wilkins
90-90 Traction
Useful for subtroch and
proximal 3rd femur fracture Especially in young children Matches flexion of proximal fragment Can cause flexion contracture in adult
Brooker AF, Schmeisser G. Orthopaedic Traction Manual. 1980. London: Williams & Wilkins
pouch, NV structures, and growth plate in children Place just proximal to adductor tubercle along midcoronal plane At level proximal pole patella in extended position
Brooker AF, Schmeisser G. Orthopaedic Traction Manual. 1980. London: Williams & Wilkins
along axis of femur Used for superior force acetabular fx and femoral shaft fx Used when strong force needed or knee pathology present
Brooker AF, Schmeisser G. Orthopaedic Traction Manual. 1980. London: Williams & Wilkins
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